Neurotherapeutic potential of erythropoietin after ischemic injury of the central nervous system

Erythropoietin (EPO) is one of the most successful biopharmaceuticals in history and is used for treating anemia of different origins. However, it became clear that EPO could also work in a neuroprotective, antiapoptotic, antioxidative, angiogenetic and neurotropic way. It causes stimulation of cells to delay cell apoptosis, especially in the central nervous system. In rodent models of focal cerebral ischemia, EPO showed an impressive reduction of infarct size by 30% and improvement of neurobehavioral outcome by nearly 40%. A large animal model dealing with ischemia and reperfusion of the spinal cord showed that EPO could reduce the risk of spinal cord injury significantly. In addition, some clinical studies tested whether EPO works in real live clinical settings. One of the most promising studies showed the innocuousness and improvements in follow-up, outcome scales and in infarct size, of EPO-use in humans suffering from ischemic stroke. Another study ended unfortunately in a negative outcome and an increased overall death rate in the EPO group. The most possible reason was the involvement of patients undergoing simultaneously systemic thrombolysis with recombinant tissue plasminogen activator. An experimental study on rats demonstrated that administration of EPO might exacerbate tissue plasminogen activator-induced brain hemorrhage without reducing the ischemic brain damage. This case shows clearly how useful animal models can be to check negative side effects of a treatment before going into clinical trials. Other groups looked in human trials at the effects of EPO on the outcome after ischemic stroke, relation to circulating endothelial progerdtor cells, aneurysmal subarachnoid hemorrhage, traumatic brain injury, hemoglobin transfusion thresholds and elective first-time coronary artery bypass surgery. Most of the results were pos-让ive, but are based mostly on small group sizes. However, some of the most neglected facts when focusing on experimental setups of ischemia of the central nervous system are issues like age and comorbidities. It might be extremely worthy to consider these points for future projects, because EPO might influence all these factors.

Ischemia and reperfusion injury of the spinal cord:experimental strategies to examine postischemic paraplegia

Thoracoabdominal aortic replacement,necessary in case of injuries,aneurysms and dissections,shows a high complication rate as a consequence of the perioperative ischemia/reperfusion-sequence（I/R）.Clamping above and below the lesion leads to the spinal cord suffering from ischemia.Clamping times of less than 30 minutes show only a small risk of neurological deficit,

Strategies to prevent and detect intraoperative spinal cord ischemia during complex aortic surgery:from drainages and biomarkers

Spinal cord ischemia(SCI),a frequent complication following open and endovascular thoracoabdominal aortic aneurysm(TAAA)repair,is a feared complication with relevant impact on a patient's quality of life.In the early days of open TAAA repair,more than one third of the patients suffered from SCI.Nowadays,due to improved preventive measures and the option of staged endovascular TAAA repair,10%of all patients are affected by spinal cord problems after TAAA repair(Rocha et al.,2020).